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Retired NBME Free 120 Answers
step7777
Not to mention orthostatics in the hospital imply a sudden change based on positioning. This patient didn't go from lying down to standing suddenly (just bitter bc I also chose autonomic dysfunction.
+3
jbrito718
Hypokalemia would present with muscle weakness. Autonomic dysfxn is a decreased baroreceptor sensitivity so we would not see appropriate correction with elevated feet (over correction/hypertension would be seen). Isotonic saline would not correct hyponatremia, it would probably make it worse (dilution effect). MI would have different symptoms.
+2
faili7777
@jbrito718
I think you misunderstood something.
People who do marathon are really susceptible to hyponatremia.
And the treatment for hyponatremia is literally '0.9% saline' because it is isotonic. So it's used to treat 'hyponatremia'
+2
stenebee
also chose autonomic dysfunction since I thought orthostatic hypotension had to measured in a much short time interval than 30 minutes apart like this question indicates (85/50 at first, 110/70 thirty minutes after leg elevation/saline infusion). My brain was thinking the repeat measurement would need to be within 1-5 mins for it to be orthostatic hypotension, & per AAFP "Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position."
ughhhhh :)
+
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mdmofongo
This one is tricky and come downs to choosing the โbestโ option. I can see why you were confused. However do note that in an autonomic dysfunction you will never present tachycardia as this patient does. I guess the key here is seeing how her BP normalizes once she is laying down? Sorry, this one is a kinda unusual presentation of Orthostatic hypo.
+
mamed
Not sure if this is correct thinking but how I got this right was:
1. She is hypovolemic
2. Likely retaining salt so water follows (ADH or just renal dynamics in general). This is how I ruled our hypokalemia and hyponatremia
3. If she is hyponatremic b/c sweating then why wouldn't she also be hypokalemic? so both have to wrong because both can't be right
4. Volume depletion ==> orthostatic hypotension
+2
blah
I thought that orthostatic hypotension was more of a chronic condition, but I fooled myself into believing that.
+1
cbreland
I completely read over the initial BP measurement and picked the wrong answer (mostly b/c of that). Test in 4 days lets get it!
+4
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submitted by thisquestionsucks(9)
This question is kinda whack. Right away, I could tell this was exercise-induced collapse, which happens pretty often to runners. I picked autonomic dysfunction because I didn't realize that this is considered an "orthostatic hypotension." After a long race, runners have a decreased SVR from all of the blood flow going to muscles. Once they stop, blood pools, doesn't get back to the ol noodle and they collapse. But ffs I still didn't pick orhtostasis because I think of old people. Fuck me